Trans Rights are Human Rights: Why Medicare for All Has to Include Gender Confirmation Surgery

We’ve placed ourselves in a significant cultural moment. Over the past few weeks, in various states, people have been marching for structural changes in law enforcement, demanding accountability and justice as they honored George Floyd and Brianna Taylor, among countless other deceased but innocent black lives. In the majesty of the movement, all of this pointed to something special, indicating who we are.

In the 2010 comedy, The Trotsky, about a teenage kid who believes himself to be the reincarnation of the communist revolutionary Leon Trotsky, the film asked the poignant question: are people bored or apathetic? The difference being that apathy is a valueless state, wherein an individual simply doesn’t care about reshaping their world, whereas boredom is a “slumber from which one can be roused,” a sense of helplessness rather than hopelessness, with the former being easier to remedy. (For, it’s impossible to alter an environment that isn’t subject to external influence.)

And, recent events have shown us that, in fact, we felt bored and helpless, that all we needed was a spark. So, in moving forward and recreating the world, I believe that it’s important to focus on transgender issues in the context of healthcare, asking what we owe the transgender community from a political, and collective, standpoint.

I’m going to begin by taking for granted the necessity of a government sponsored medicare for all program. As space is limited, I’m not going to argue for why we ought to have a fully state subsidized healthcare system, but why we ought to include the needs of the transgender community in it. Thus, if the purpose of medicare for all is to preserve and restore the mental and physical health of its policy holders, that must entail all of them. And, I’ll get to what I mean by that in a bit.

From a clinical perspective, when transgender people enlist the help of a mental health professional, they usually do so because of a deep-seated sense of shame. Sometimes, the shame results from feeling as though they don’t belong, which usually originates from familial rejection. But, at others, it’s either compounded by, or solely stems from, the sense that they’re deformed. A former client of mine, who’s engaged to a transgender man, frequently spoke about how her partner felt when using the bathroom; he’d take down his shorts and automatically feel disfigured. His genitals were a constant reminder that he couldn’t be the person he conceived himself as being, that he would always be someone, or something, in between.

And, this is one of the global plights of transgender individuals: they know themselves to be someone whom they can’t outwardly perceive. The answer may seem simple; one can easily recommend any one of them to a therapist. Although I agree that treatment can play some role in fostering their well-being, it can’t fix the discrepancy between their intuition and perception. Imagine wholeheartedly believing that you were born into the wrong gender, thinking that the universe decided to play a cruel joke on you, that not only did it create the dichotomy I mentioned but also made transitioning impossible.

If my core belief tells me that I’m deformed, then each time you tell me that, in reality, I’m not a man, I’ll interpret your words through the lens of that belief; it’ll be as though you’re cutting me with a thousand blades. At times, our messages are overt, but they can also be subliminal. And, as a country, by standing on the sideline and, perhaps, being apathetic, we implicitly inform transgender people that their suffering is insignificant, that, maybe, they should just see a therapist, implying that they can’t seem to accept reality.

However, no amount of therapy can delude them into believing what they can’t see or what they can’t feel. So, if we maintain our progression and use this substantial cultural moment to continue to move forward, resuming our fight for equality in healthcare, we ought to make gender confirmation surgery an aspect of that system, moving it from the realm of mere cosmetics to incorporate a more enlightened understanding of mental health. If trans rights are human rights, then it’s on all of us to accept the only reasonable solution.

As gender confirmation surgeries cost upward of $30,000 (some even cost over $100,000), most transgender individuals can’t afford them. But, we can. Some of the money spent and wasted on corporate subsidies can be redirected to them. The argument on the other end will be: why should I spend my money on improving someone else’s self-conception? And, I’d respond, asking: what did I do to deserve feeling whole in who I am? Why don’t I have to spend $30,000 just to feel like I’m a human? Unfortunately, the misconception is that transgender people are simply attempting to cultivate their beauty when, in fact, they’re just trying to feel normal.

If we’re serious about human rights, and if we’re serious about caring for the mental and physical wellness of everyone who lives here, we have to include, and care for, all of our vulnerable populations, placing a high priority on sustaining their well-being.

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